Name *
Date *
Was your most recent dream more than 7 days ago? *
Mark yes, only if you have not dreamt in the past week while sleeping.
0 = gone, 10 = worst ever. (e.g., Back Pain = 5, Flu = 2, Depression = 0)
Which sensations got worse since our last session? Approximate in the last week or days, on a scale of 0 to 10.
e.g., use healing master in aroma lamp, or none.
e.g., stress, routine, work, etc?
e.g., 1 glass of wine, a bottle of Scotch whisky, none.
e.g., neck pain, cramps, headaches, sores, spasms, etc.
e.g., depression, unhappy, confused, stressed, fearful, etc.
Please indicate any recent or chronic pain.
e.g., other therapies or activities are more effective, you need dream interpretation, etc.

If you would like to resubmit you goals, download the first appointment forms.